Monthly Archives: October 2013

Research is among several Mayo studies being presented at American College of Rheumatology meeting

SAN DIEGO — It may seem counterintuitive, but young and middle-aged fibromyalgia patients report worse symptoms and poorer quality of life than older patients, a Mayo Clinic study shows. Fibromyalgia most often strikes women. It is characterized by widespread musculoskeletal pain with fatigue, sleep, memory and mood issues. The research, one of several Mayo studies being presented at the American College of Rheumatology annual meeting, suggests the disorder plays out differently among different age groups.

MULTIMEDIA ALERT: Video of Dr. Oh is available for download from the Mayo Clinic News Network.

Researchers studied 978 fibromyalgia patients and divided them into three age groups: those 39 or younger, those 50 to 59, and those 60 or older. The younger and middle-aged patients were likelier to be employed, unmarried, smokers and have a higher education level, lower body mass index, more abuse history and a shorter duration of fibromyalgia symptoms than older patients.

“Among the three age groups of young, middle-aged and older, symptom severity and quality of life differs,” says senior author Terry Oh, M.D., a physical medicine and rehabilitation physician at Mayo Clinic in Rochester, Minn. The study’s findings were surprising, because quality of life and physical health are considered to be negatively associated with age, Dr. Oh says.

Dr. Oh notes that women in all three groups with fibromyalgia reported a lower quality of life than average U.S. women, and that the difference between their physical health and that of the average woman was more significant than mental health differences, particularly in young patients.

In other studies, Mayo researchers found:

About 7 percent of fibromyalgia patients had inflammatory rheumatic conditions, and that in general, those fibromyalgia patients didn’t do as well with treatment as those without rheumatic diseases.

Fibromyalgia patients may also have skin-related symptoms such as excessive sweating or burning or other sensations.

Obese patients with polymyalgia rheumatica have more pain and disability than other polymyalgia rheumatica patients. They also tend to need higher doses of glucocorticoids.

Rheumatoid arthritis patient experiences and symptoms do not always reflect what medical literature shows when it comes to pain, morning stiffness, the relationship between swelling and damage, and what worsens or improves symptoms.

Hospitalization is a significant risk factor for gout flares in people already diagnosed with gout.

Patients with fibromyalgia resistant to more routine therapies have a new pain relief treatment available, according to a study presented at theANESTHESIOLOGY™ 2013 annual meeting. Intravenous (IV) lidocaine infusion provided significant pain relief to fibromyalgia patients, although the pain relief was much less for African-Americans and smokers.

Fibromyalgia is one of the most common chronic pain conditions. The disorder affects an estimated 10 million people in the United States and an estimated three to six percent of the world population. Women account for 80 to 90 percent of those with the condition. Fibromyalgia is a central nervous system disorder characterized by widespread pain throughout the body as well as a heightened, painful response to pressure. Additional symptoms include fatigue, sleep disorders and joint stiffness.

“Fibromyalgia is a truly debilitating disease that can have a severe impact on quality of life,” said Billy K. Huh, M.D., Ph.D., professor and medical director of the Department of Pain Medicine at The University of Texas MD Anderson Cancer Center, Houston, and adjunct professor of the Department of Anesthesiology at Duke University Medical Center, Durham, N.C.

The study was a retrospective review of 55 fibromyalgia patients whose pain did not respond to more conservative treatments. Statistics were collected for sex, race, body weight, pain duration, pain relief duration after lidocaine infusion, and scores on the brief pain inventory scale, visual analog scale and pain interference scale before and after the infusion.

The study found an almost 10 percent average decrease in the brief pain inventory scale score, which dropped from 83.18 before the infusion to 73.68 after the infusion. The average pain interference score dropped from 7.73 to 6.88. The brief pain inventory score was much lower for non-smokers than for smokers; non-smokers’ average score was 72.63, while smokers’ average score was 89.98.

Dr. Huh hypothesized that because smokers frequently have vascular damage that impairs blood circulation, the lidocaine may not reach the painful area because of poor blood flow. He also suggested that the benefit of lidocaine may be reduced because smokers have significant amounts of toxic chemicals in their blood.

The difference in pain interference scores for white patients and African-American patients was .028. For this test, a score less than .05 is considered statistically significant. Dr. Huh could not be certain about the reason for the difference, but noted, “Many drugs are more effective or less effective for certain ethnic groups. For example, some blood pressure medications are more effective for certain races. I think this finding is quite possibly related to genetic makeup.”

The American Society of Anesthesiologists
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 50,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.